General Introduction to ECG

General Introduction to ECG

Reading Assignment (p2-16 in PDF `Outline')

Objectives 1. Practice the 5-step `Method' 2. Differential Diagnosis: R & L axis deviation 3. Differential Diagnosis: Poor R-wave progression 4. Differential Diagnosis: Prominent Anterior Forces

Welcome to the "5-Step Method"

ECG #:

Mearurements: A= V= PR= QRS= QT= Axis=

Rhythm (s):

Conduction:

Waveform:

Interpretation:

1. Compute the 5 basic measurements: HR, PR interval, QRS duration, QT interval, Axis 2. What's the basic rhythm and other rhythm statements (e.g., PACs and PVC's) 3. Any conduction abnormalities (SA blocks, AV blocks (Types I or II), and IV blocks 4. Waveform abnormalities beginning with P waves, QRS complexes, ST-T, and U waves 5. Final interpretations: Normal ECG or Borderline or Abnormal ECG (list final

conclusions)

30 year old woman (explain the sequence of activation from sinus node to ventricular muscle)

What are `septal' q-waves?

1-1

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*

*

*

1-1

Mearurements: A=55 V=55 PR=140 QRS=100 QT=430 Axis= +80

Rhythm (s):

Conduction:

Normal Sinus rhythm Normal SA, AV, IV conduction

Sequence of conduction: ? SA node (RALA) AV

node His Bundle RBB & LBB LAF & LPF & LSF Purkinje network left septal surface (onset of QRS)

Waveform:

Interpretation:

? Normal P, QRS, ST, T; note normal U waves in precordial leads (*)

? Septal q`s in II, III, aVF

Normal ECG (septal q-waves normally seen in II, III, aVF in ECG`s when the QRS axis is > +60; see arrows)

(onset of ventricular activation begins on the left ventricular septal surface resulting in small septal q-waves)

I

II

III

65 Year old woman Where are the `septal' q-waves?

1-2

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